Provider Demographics
NPI:1558435586
Name:LEADING EDGE MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:LEADING EDGE MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-491-1581
Mailing Address - Street 1:4607 LAKEVIEW CANYON RD # 658
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4028
Mailing Address - Country:US
Mailing Address - Phone:805-491-1581
Mailing Address - Fax:
Practice Address - Street 1:2660 TOWNSGATE RD STE 720
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5707
Practice Address - Country:US
Practice Address - Phone:805-491-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16449251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health